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WALGREEN CO.
DSH050335 Sonora Community Hospital DBA Adventist Health Sonora
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Covered Entity Details
Entity Name
Sonora Community Hospital DBA Adventist Health Sonora
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050335
Entity Address
1000 Greenley Road
Sonora, CA 95370
Medicare Provider Number
050335
Participating Start Date
4/1/2017
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12528
475 HIGHWAY 49
SUTTER CREEK, CA 95685
Pharmacy Comments
Contract Details
Approval Date
1/7/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Greg McCulloch, President
(209) 536-5012
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/7/2021
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